Provider Demographics
NPI:1962698969
Name:HURD, ALEXIS RACHELLE (MSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RACHELLE
Last Name:HURD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:RACHELLE
Other - Last Name:HURD-SHIRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:612 SE JACKSON ST STE 11
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4956
Mailing Address - Country:US
Mailing Address - Phone:541-464-6455
Mailing Address - Fax:541-464-6457
Practice Address - Street 1:612 SE JACKSON ST STE 11
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-4956
Practice Address - Country:US
Practice Address - Phone:541-464-6455
Practice Address - Fax:541-464-6457
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMSW 6923104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker